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Friday, August 29, 2014

I started injections for ovarian hyperstimulatimon

I started to take birth control
pill 12 days before my expected menstrual period. I do it to make sure that I
get my periods on time. There were times when I wait and wait for my periods to
start and it never happened. The reason was, either I failed to ovulate that
cycle or I ended up with a cyst which prevented my periods. So, to be on the
safer side, I took birth control pills. After 7 days on birth control pills, I
started taking lupron too (overlapping BCP and lupron). I stopped BCP after 10
days and continued only lupron. When my period arrived, I started FSH
injections on day 3 of my menstrual cycle (lupron continued until egg
retrieval). Don’t ask me the name of this protocol. This is what has helped me
previous time to get more eggs and so we followed the same.

I ordered medicines in Madurai.
In the beginning, I was scared. Medicines necessary for IVF will not be
available in nearby medical shop (definitely not in our village). In a small
city like Madurai, I was wondering, where will I go in search for it? But to my
surprise, I found that, I could order all the medicines from home. I
just have to call the pharmacy and order the medicines and they delivered the
medicines to my home safely in a cool pack. I never expected this in Madurai
and I was relieved. If any of you staying in Madurai was wondering how to order
the necessary medicines, please contact Vasan medicals. They are very sincere, and
prompt. They do their best to get the medicines you ask for in time.

I called Vasan medicals and the
first question I asked them was which FSH preparation is the cheapest in the
market. FSH is available in 3 different forms – Gonal F, Menopur and Menogon.
Gonal F is the purest form of FSH. It is a recombinant preparation (genetically
engineered) and hence very costly too. Menopur and menogon are prepared from
the urine of post-menopausal nuns and hence called as hMG (human menopausal
gonodotrophins). They are of course purified (not as pure as Gonal F) and
contain equal amounts of LH and FSH. Menopur is a much purer version than
Menogon. Menogon is the cheapest. I ordered Menogon. I used Gonal F for my
first five IVFs in Germany. My ovarian response to Gonal F is very, very poor.
But when I came to Dr. Malpani for my 6th IVF, I was given menogon
and I responded so well to stimulation and produced many, many eggs. Might be I
needed LH too for getting my follicles to grow. So, when you are given an
option to select between gonal F and menogon, chose the cheaper one. Scientific
studies have failed to show that one form of FSH preparation is superior to the
other.

When I got all the medicines and
when my mom saw it, her eyes became so wide for a moment and then watery too.
She asked with fear, do you have to inject them. I said, amma I am so used to
it. I don’t even feel any pain. If at all I feel something, it is just like an
ant bite. From that day onwards I made sure my mom doesn’t see me injecting the
medicines. Many women who are about to start IVF ask me with fear, "I am so
sacred of injections, will they hurt?” Believe me, they don’t. I think, when
compared to all the emotional turmoil we undergo during IVF, pain caused by
these injections are nothing, absolutely nothing. If you are afraid of these
injections, how will you face the pain of child birth? They say childbirth is
the worst pain you could ever feel. I actually like those injections (FSH) for
another reason. They are like costly anti-aging drugs (who wouldn’t love to
look younger!). This is what my RE in Germany says. I truly, truly believe so.
When you take those injections and when your estrogen level starts rising, it
is a wonderful feeling, at least for me (I know women who suffer from nausea
and other side-effects because of it). I feel like a teen ager. My thoughts
change. I become so optimistic, I sleep too well and my skin becomes beautiful.
Do you remember the first time you fell in love as a teenager (your first
crush), it feels exactly like that! As a scientist, I am amazed to see and feel
by myself how hormones could control our brain, our thoughts, perhaps our
actions too. Is there anyone out there who could relate to what I say (very
curious to know)? So, please do not panic about your injections. They are not
as evil as you might think. One another fear most women have about IVF drugs is,
“will I put on much weight when I take them?" I have heard women complain – “only
after I started using them I became fat”. Please be assured that it is
not true! What makes you gain weight is the depression that you go through
during your infertility treatment. Because of the stress and depression, you unknowingly increase your food intake. Eating food, especially
which are rich in carbohydrates, creates a feel good sensation due to the
release of a hormone called serotonin. In order to beat depression, many women get
addicted to the effect of serotonin and overeat unknowingly. The best way to
prevent weight gain during fertility treatment is to develop creative
strategies for beating depression. In my case, infertility actually helped me to
maintain a healthy BMI. I understand the impact of body weight on fertility and
I don’t want to put myself through another problem, I think I already have enough problems to
tackle!

Rajender came to Madurai. I was
eagerly waiting for him. How happy I was to see him! The first question I asked
him was, “did you miss me?” He replied with a naughty smile, “no, never!” But
his happy face said otherwise. I took my medicines for the first four days in
Madurai, and on the fifth day we were in Mumbai for my first ultrasound. I
asked Dr whether I could come to Mumbai much later, after 8 days of taking
stimulation drugs (I thought I will reduce the hotel expenditure there, Mumbai
is of course costly!). He was not happy. He said, “If you want to do so, I need
a very good digital picture of your ovaries after 4 days of starting
stimulation”. I was so sure I wouldn’t be able to get a digital picture (I
remembered the not so cooperative doctor in that scan center). He said, “Manju, don’t be penny wise and pound
foolish. It is better we monitor you closely so that we can adjust your
stimulation drugs as and when needed, this will provide you with a high chance
for having an optimal outcome”. So, we were in Mumbai a lot earlier this time
and I love Mumbai.

Mumbai is very beautiful and
lively. People are friendly. Shopping areas are amazing. But the most important
attraction for me in Mumbai is the Marine Drive area. I just love to sit and
watch the sea. I feel so happy and relaxed when I do so. One thing that makes
me sad about Mumabi is the wide-gap I see between the rich and poor people. There are overwhelmingly rich people who drive BMW and dine in Taj, and
on the other hand I could see poor people, especially poor children who are
just left on streets. I really, really feel guilty at such times for pursuing a
costly way to have a baby, after all a baby, which are present in abundance in India, even on roadsides (babies, babies everywhere but not even one for me !) Once I was walking near the Taj
hotel. The beauty and richness of it always amazes me! There were so many Benz,
BMW and Jaguars parked there. Rajender was telling how much those cars would
cost. I was hearing it open-mouthed. I thought what a life it is! I wanted to
be that rich too. I want to drive a costly car, enjoy my evenings in a five
star hotel like Taj and want to live like a queen (who wouldn’t want to!)
Caught up so much in those thoughts I forgot to see the foot path. I was
about to stamp on something and Rajender pulled me aside and looked at
me angrily (It happens many a time when we go out, most of the time I will be
too attracted by what I see or will go into dream mode). I looked down and realized that I was about to place my leg on
the hands of a 12 year old girl. All my excitement drained in a second. There lay
a poor girl, near that richest hotel, clothed in rags and with a small torn bag
under her head (I hope it is her only possession). She was fast asleep in that
busy roadside (serenity amidst chaos!). I was ashamed of my inability
to do anything for such unfortunate children, yet, desiring after things which could make my life even more comfortable. I felt guilty. I was angry and bitter, I cried. People like me,
easily blame Karma for such inequality and unfairness, and move on with their life. I realized that there are so many
things in my life I must be grateful for. I had a safe childhood, I couldn’t
imagine the life that little girl was leading. How unsafe it is for a girl to
live on streets! I have a shelter above my head, I have good clothes to wear, I
have food not only to satisfy my hunger but I could have food for my enjoyment
too. If I start writing the things I must be grateful for I need several,
several pages. If that is so, do I have any right to complain about
infertility, not being able to have a child?

I went to the clinic for my first
scan after four days of taking 300 IU Menogon. I was very happy when I went in.
I was eager to meet everyone, especially my Dr. I was very eager to know how I
am responding to stimulation. But when I came out of the clinic I was too tired,
tired of crying my eyes out!

Manju, please give us a twist in the tale that all of us are praying and wishing for you! It is ought to happen come what may..thinking and praying for you!

My ET went well yesterday thanks to all your wishes and guidance! We transferred 2 day-5 blasto grade A (one is hatching and second is early blastocyst) after they come out normal in a PGS..rest two were abnormal..I am little disappointed that from my 9 thawed embroys (all survived thawing), only 4 could reach a stage suitable for PGS and of which only two were normal..so no balance left now :(( I was very hopeful of having some balance, incase this one does not work out! Very sad due to that..

you please keep us posted and never lose hope! There are just too many people praying for you to make your dream come true!

Happy to hear that everything went well. What kind of genetic testing, did they test all the 24 chromosomes ? Enjoy your 2ww, Take one day at a time. I am sure your embies will snuggle in tight. Good luck ! May your dream come true !

Yes my mama (mother's brother) does have diabetes...but I doubt I have prod..I mean never had any issues with my periods ever..always had them two-three days here and there..not even sure if I tested my insulin ever...

Thanks for the info ! Sometimes women with high insulin levels in their body, undergo first trimester m/c often. You don't seem to have any typical symptoms of PCOD, so I think it is very unlikely you have such issues.

Every post of yours leaves us waiting eagerly for the next post. wishing you very best for this new cycle.

I also have a question. Does high prolactin results in IVF failure? I have failed a few rounds of IVF. I tested my prolactin recently and it was 30.Rest everything is fine, and dr. Doesn't seem to understand the reason of these failures.

High prolactin can result in poor egg quality. Your prolactin levels doesn't seem to be too high. When was it tested, before or after an IVF cycle ? What is your TSH value ? How many embryos you got during your IVF cycle ? How many were transferred ? Did the embryos develop according to their age ?May I know your age, please !

Prolactin levels can vary a lot due to several reasons. Even breast stimulation could raise prolactin levels. Hypothyroidism can raise prolactin levels too. Since your levels are not that high, I wouldn't suspect prolactin levels to be the reason for failed IVF. Do you have PCOD ?

Only if you could give the entire details of your cycle, we might be able to get a much clearer view.

Hi.I am 29. The levels were tested after the IVF cycle. I do have autoimmune hypothyroidism but tsh is below 2 due to throxine medicine which i take regularly.I do not have PCOD and my cycles are regular. got 5 embryos and they did grow according to their age. One of them was 10 cells on day 3. We have transferred all the embryos in total 3 transfers ( one fresh transfer and 2 frozen transfers)

Do you have endometriosis or the scarring due to some infection ? Is the cause for infection known ? Is your BMI normal ?

I would suggest you to measure your prolactin before your next IVF cycle ? If it is elevated it can be easily brought down using medicines.

You are young, produce decent amount of eggs and embryos. Your chance of success with further attempts is pretty high. Remember, 60% of women conceive within 3 IVF cycles ( you have gone through only one ). I hope your further cycles get even better and you conceive. If you are confident that you are with a good clinic and believe in their ability to create good embryos, all I would suggest is to repeat the cycle. You can try a blastocyst transfer next time. This will give you much insight regarding your embryos competence. Please see your embryos before transfer and make sure you get photos of them !

Yes it was treated appropriately around 5 years back, when I had it.Do I again need to take antibiotic course for next IVF?Also, hydrosalpinx was ruled out by my doctor when I asked her this. She saw the HSG reports for it. But I did hsg around 2 years back. Laparoscopy has also been done.Do you think I need to repeat the tests for hydrosalpinx, since it's been time when we did it last.

My serum progesterone has dropped from 19.4 on 21st Aug (day 1 post transfer) to 12.1 on 25th Aug. Is this a sign of worry? I am taking uterone 50 injection every alternate day and Gestone 400 (vaginally) twice a day. I have sent an email to my doc but wondering if you have any thoughts?

really? Not sure why my doc asked me to repeat it then? And I just searched on net - ppl are freaking out with falling progesterone in the 2ww after FET! But just to understand it better, don't we need healthy amount of prog. for implantation and sustaining early pregnancy?

Vaginal pessaries deliver progesterone where it is needed most - to the uterus. They are not absorbed into the blood. So in FET where there is no corpus luteum, your progesterone levels in blood tend to register a lower value. In my clinic they never check progesterone levels after they put the patients on vaginal pessary. I never took progesterone injections too. When I was pregnant with my twins my progesterone levels at 10 weeks was 8 ! Your progesterone levels will not say whether you are pregnant or not. Might be the clinic which checks progesterone in blood believes a blood level below 20 will not support uterine lining which is obviously not true when you are taking progesterone vaginally.

Thanks for a detailed explanation Manju! very helpful. My doc has reverted with the advice to change the alternate day injection to a daily one! May be they just want to play safe and do everything to help us conceive!

Manju, i am glad to hear that you are working on a stim cycle and i wish you much luck. I am also struck by the cliffhanger in your post- if it is not going well, i hope that it may turn around by cd8. my best ivf cycle, i stimmed the longest and had the best results of all remaining cycles.

Your blog is very informative and it really helps people undergoing IVF to take some time and think, plan and move ahead.I wanted to ask you for the protocol that you use before stimulation. I.e bcp with an overlap of Lupron . Was it being suggested by your current RE or is this something that you have researched and then started administering.

I have used antagonist and microdose lupron flare protocols. The problem I had with both these protocols was, I ended up with few follicles and there was lots of discrepancy in their growth, they grew asynchronously. When I went to Dr. Malpani, I had to take BCP so that it is easier to plan the cycle. That time I came across Dr. Sher's article about why it is important to overlap BCP with lupron. Please do a Google search ! I also started with higher dose of FSH in Dr. Malpani's clinic. Something worked :)

If you could give me your personal situation, I could help you better. Every human body is different. It is hard to pinpoint what works best. If the ovarian reserve is good, most protocols will work. The problem arises if the ovarian reserve is poor. If the AFC count is less, then it is impossible to coax the ovaries to produce more eggs than that. This is the sad truth !

Hi Manju,Thank you for replying back. Would you mind sharing how much dosage of Lupron were you on ? Did u continue the same Lupron dosage along with the stimulation FSH meds or did you reduce the Lupron.

I am 34+ year old, diagnosed with anovulatory disorder/pcos since last 8-9 years. I have been thro' few IVF cycles myself. The first one was the long Lupron protocol. I took bcp piklls with overlap of Lupron. Then continues fsh stimulation with lower dosage of Lupron. It wasn't a great cycle as though I retrieved a large number of eggs (20), I got only 7 mature. 3 made it to blast, got positive beta in fet cycle, but m/c at 6 weeks. AFC was 21, AMH -> 6.1

Same thing happened for Antagonist protocol. 19 eggs, mature 8 . Only one made it to blast.AFC was 20, AMH -> 4.5

The current fertility specialist that I am referring is suggesting will start . Lupron for 3 days (from day 1 of cycle) and then Menopur (300IU) along with same dosage of Lupron.I am a little worried if 3 days of Lupron down regulation with Lupron will be enough. he hasn't mentioned to use bcp. Also, does the dosage of 300IU look too high ?I have been reading some articles on Dr Sher's blog too and he doesn't seem to advocate for high dosage Menopur for PCOS patients. Do you have any suggestions regarding this ?

Lupron 20 units everyday in a 100 unit insulin syringe. I am really, really sorry. I don't know the exact dosage. I continued the same dosage throughout my cycle. But, using lesser lupron doesn't lead to more eggs or promote the growth of follicles better. Lupron has an entirely different function, it acts on the receptors in brain. So please do not worry about the dosage of lupron. Three days of downregulation of lupron is enough to achieve a pituitary suppression. Please do not worry !

I understand your fear and you are a lot confused too. You get lots of eggs. Your problem is that, the eggs retrieved are not mature enough. Perhaps your current RE thinks more FSH and longer stimulation can lead to mature eggs. I am sure they have enough experience in treating PCOD patients. I find no fault in the protocol he has suggested. The protocol you are going to use is flare protocol. Some people argue that it is not apt for PCOD patients. This is because lupron for the first 3 days of administration increases your body's own FSH and LH. This creates a flare effect which jump starts your follicles. After 3 days lupron prevents your body's own FSH and LH production. The stimulation meds you will be taking continues to help in the growth of your follicles further. Since PCOD patients already have high circulating LH, many don't advise using this protocol for PCOD patients thinking that high LH might compromise endometrial lining receptivity. But, you must understand that there are no universal rule. Every patient is different, there are no common pattern. Might be your current RE has good experience with this protocol for PCOD patients. I would follow his advice without worrying.

But, you can do one thing. If you get enough embryos, please transfer only one in a fresh cycle ( or none) and freeze the remaining. Since you produce lots of eggs, your estrogen levels can rise too high which can spoil lining receptivity. Frozen transfer could overcome this problem.

Are you on any meds for PCOD ? Myoinositol ? Metformin? Are you overweight, insulin resistant ?

I must tell you. You are doing a great service by providing guidance to confused souls like me. The whole IVF process itself, though being a boon for us, has so much unpredictability that each attempt feels like a roulette game. The only thing we can do is to try to know and understand what we can and probably be a better advocate for ourselves.

Thanks for guiding me on the Lupron. In my first IVF cycle and also for the FETs, I had a long Lupron suppression and it was no fun at all. I was so miserable with severe headache due to lack of estrogen in my system and only when the estrogen support started, I felt better. I hope you did alright. So, I guess I should feel good about the fact that short Lupron suppression is being suggested :) . My body would probably thank me.

Yes. You are probably right ..that RE thinks that more FSH with carefully monitoring stimulations/trigger could help me with more mature eggs. It is just that it is not a very recommended approach and that start playing with my mind. I guess, if I trust the RE, I will have to bring myself to trust the approach.You did make a very valid point of not transferring or transferring one embryo if the endometrial lining does look compromised. There is so much effort that goes in getting a good embryo. It doesn't make sense to transfer just for the sake of making use of the cycle.My last ivf (antagonist protocol) resulted in just one blast (fair quality). I had it transferred in a frozen cycle. I got good positive betas but unfortunately this one too didn't progress beyond 5 weeks. One thing that I was thinking after that failed cycle was to probably have a more bank of embryos and then do FETs. It's just that sometimes it becomes financially difficult to shell out lot of money for extraction cycles one after another. Plus there is lot of uncertainty that can creep up if an EC cycle doesn't go as per expectations. Hope I can hang in there enough to keep the tries on.I was on Metformin for a long time. Yes, overweight and trying to loose weight thro the diet and exercises. I did stop Metformin a year back as I was having of stomach issues, migraine flares. My fasting blood sugars were normal , haemoglobin a1c was normal. So, my RE suggested that I can take break from all medication except the thyroid medication that I was on. I very recently started Myoinositol. Read some positive reviews about it. Even if it can help a little percentage in egg quality, I guess I will take it. I will definitely keep you posted on my cycle. It is going to take some time because I am giving myself a little time to get a little more fit, let the Myoinositol work. I was being told for COQ10 too. I am yet to decide on that one. Have you tried it ?

I sincerely pray that this cycle of yours goes well with the transfer. Sending you all the positive thoughts."Life may not be the party we hoped for, but while we are here we might as well dance" Author Unknown.

Shivani, I am so happy that you are doing your best to learn things and advocate for yourself. That is the first step for having a successful IVF ! I am sure your efforts and your positive spirit will definitely pay off.

It is very, very important to have a healthy BMI. Was your fasting insulin checked anytime ? PCOD women with high insulin are prone to early miscarriages too. Your decision to take some time to get back to a better health is very wise. Do your best and leave the rest to God/Nature.

I looked thro' the hoards of blood work that I have done in the past and I don't see fasting insulin test result. I can see fasting glucose ( 74), Glucose 1 hr (94), Glucose 2 hr (105), Lipid Panel, Chem Panel, Haemoglobin A1C (5.0). I don't know why fasting insulin wasn't tested in all these years. Do you think i should talk to RE and get it done ?

I agree on the BMI part. The more I read about it, more stupid I feel for not being able to maintain a healthy BMI all these years. It's not that I haven't tried. At times I have been on regular exercise routine and have been able to loose weight. But again, there were times of hectic work schedule with sedentary nature of work and negligence on my side , that did bring the weight back. Well, the time lost can not be brought back. I guess. next 1-2 months with focus on my health , I can just hope for a maybe better result.

Myoinositol and metformin both work as insulin sensitizers, they help your body to use insulin efficiently. This in turn leads to reduced androgen levels and gonodotrophins (LH) which leads to ovulation. Did you ovulate when on metformin ? Did metformin regularize your periods? Measuring insulin will just make sure that your body has insulin handling problem. If you wish to you can do it in a nearby lab too !

Please don't beat up yourself ! We all neglect our health at times. I am sure now you will do a good job. If I were you, I will avoid all form of simple sugars and stick to only complex carbs. You can also look for insulin test diet on internet.

Sorry, I missed to see your comment. With Metformin, I didn't have regular periods. I did ovulate at times (Tracked it using OPK's or thro' blood draws at RE) but they were still irregular. My RE (the one which I had done with my IVF's) has no recommendation for myoinositol, when I asked she said it is ok if I want to take a low dosage along with metformin (1500). As per her, my insulin resistance is not really a problem. They typically suggest testing it out if the A1C is higher than normal or fasting sugars is up. If they are in a normal range, then insulin is getting handled.Do you think it's unnecessary to have both Metformin and Myo-inositol ? Will it cause any harm ?

I don't think taking both will do any harm. But, if myoinositol could do what metformin does ( improvement in insulin resistance ) then why to take metformin which is very hard on stomach ?

I don't agree with your doctor. A normal blood glucose or A1c doesn't guarantee that your insulin is normal. High insulin levels are detrimental. So please be on some insulin sensitizer. I would even continue metformin even after a pregnancy is established. It helps to prevent miscarriages.

Hi Manju, need some urgent advice!Sorry to disturb you at this time of pregnancy.I am about to start birth control pills (regestrone) from 1st Jan 2015 for fresh IVF cycle.My LMP date was 8th dec 2014. But today i got some bleeding. My period does arrive 8-10 days early, though very rarely. I don't know what to do now and my doctor is also not available on phone.shall i start regestrone right away to stop any further bleeding or shall i let the period start?Please suggest.Thanks

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Please note that I have no medical training or qualifications, and that the contents of this blog are thereof are opinions, not medical advice.

have medical training or qualifications, and that the contents thereof are opinions, not medical advice. - See more at: http://healthbeat.areavoices.com/2010/09/29/the-expert-patient/#sthash.YPxLA3EA.dpuf

have medical training or qualifications, and that the contents thereof are opinions, not medical advice. - See more at: http://healthbeat.areavoices.com/2010/09/29/the-expert-patient/#sthash.YPxLA3EA.dpufPlease note that I have no medical training or qualifications, and that the contents of this blog are thereof are opinions, not medical advice.

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I thrive on love and affection!

I am a 36 year old Indian woman, happily married for seven years. This blog captures the 7 year infertility journey we went through to have our daughter Anisha. I have to undergo7 IVF/ICSI cycles, three miscarriage (including a still birth where I lost my twins to incompetent cervix) and 3 FETs to have our little miracle in hand. This journey was excruciatingly painful at times yet shaped me in ways happy times wouldn't have. Looking back, I wonder about myself ! I feel proud that I was able to be sane and strong after so many IVFs and heartbreaking miscarriages. Now I am very happy and serene than if I would have had children without any problems ( a bit crazy too ! :) The secret is, infertility is a great teacher. It taught me to be strong, humble, resilient, rational, forgiving, empathizing and hopeful. BTW, I am a scientist by profession. I hold a doctorate degree in Human Biology and I believe my education has helped me to tackle infertility bravely. I would like to share my experience and knowledge which I gained during this happy struggle to meet our offspring with you all. If you could share with me your thoughts and experiences I will be very happy !